TMS and Psychotherapy: When Neuroscience and Psychology Work Together

What does the latest research reveal about the combination of TMS and psychotherapy—and why might this approach be more effective than either intervention on its own?

 

In fact, there is an unspoken divide in how mental health is treated in Portugal: medication and TMS fall under the purview of psychiatry; psychotherapy falls under the purview of psychology. Rarely does anyone explain—or investigate—what happens when the two work together. The most recent research is beginning to fill that gap with concrete data. And what it reveals is clinically relevant for anyone to consider it as a treatment option in Lisbon or elsewhere in the country.

In an article published in 2025 in Psychodynamic Psychiatry, Hale and Ruffalo propose an integrative model in which TMS and psychotherapy reinforce each other. Specifically, the central idea is that TMS does not merely target symptoms—it acts on the neural architecture that makes therapeutic work possible. This is the philosophy that guides clinical practice at The Clinic of Change in Lisbon.

Psychotherapy, psychology, and psychoanalysis: what’s the difference?

Now, this is the most frequently searched question in Portugal on this topic—and it warrants a clear answer before we proceed. Psychology is the science that studies behavior and mental processes; a clinical psychologist is a professional with academic training in this field. Psychotherapy is a structured psychological treatment process conducted by a therapist (who may be a psychologist, a physician, or another professional with specific training). Psychoanalysis is a specific form of psychotherapy, of Freudian origin, centered on the unconscious and the therapeutic relationship.

In clinical practice, when we talk about combining TMS and psychotherapy in Lisbon, we are referring to the integration of neuromodulation with any of these approaches—cognitive-behavioral therapy, psychodynamic therapy, or psychoanalysis—depending on what is most appropriate for each individual.

What happens to the brain during psychotherapy?

Surprisingly, psychotherapy produces measurable changes in the brain. Neuroimaging studies show changes in the prefrontal cortex and the limbic system in people who complete effective psychotherapy treatments. In other words: talking to a psychologist literally changes the way the brain works. This process—neuroplasticity—is the same capacity that TMS directly stimulates through magnetic pulses.

However, the problem is that this capacity is not uniformly available. In people with severe major depression or chronic anxiety, the neural circuits most relevant to therapeutic work are often impaired: the ability to process emotions, gain insight, and tolerate uncertainty. All of this depends on circuits that, in pathological states, function less efficiently.

How does TMS enhance psychotherapy?

This is where Hale and Ruffalo’s research becomes clinically relevant. By stimulating the prefrontal cortex with repeated magnetic pulses, TMS promotes neuroplasticity in the very regions that underpin the processes addressed in psychotherapy. Thus, the practical outcome can be significant: reduced psychological resistance, greater capacity for emotional processing, and increased receptivity to therapeutic work—whether cognitive-behavioral, psychodynamic, or psychoanalytic therapy.

A review published in PubMed (2024) on the combination of TMS with psychotherapy and medication confirmed initial support for integrating mindfulness interventions with TMS, and showed that adding TMS to stable pharmacological regimens enhances the reduction of depressive symptoms. The same review warns of interactions that need to be monitored—particularly with benzodiazepines—reinforcing the need for psychiatric supervision throughout the process.

TMS and psychoanalysis: an unexpected dialogue

For those familiar with the work of The Clinic of Change, it comes as no surprise that this topic includes a psychoanalytic dimension. Hale and Ruffalo specifically explore how TMS can alter transference dynamics and modify the therapeutic alliance in psychodynamic psychotherapy settings. Therefore, by reducing certain resistances, TMS can open access to material that, without prior neuromodulation, would remain inaccessible to the analytical work.

Clinics in Portugal that combine TMS and psychotherapy: what to look for

When searching for “clinics in Portugal that offer TMS and psychotherapy,” the quality criteria to look for are clear: an integrated multidisciplinary team (rather than just external referrals), psychiatric supervision during TMS sessions, and a treatment plan that explicitly integrates the two interventions. The separation between “who performs TMS” and “who performs psychotherapy” without communication between the two is a significant clinical limitation.

Specifically, at The Clinic of Change in Lisbon, psychiatrists, psychologists, and psychoanalysts work in a coordinated manner with each individual—not in parallel.

When to seek specialized help

Seek professional help if:

• You are in psychotherapy, and progress is slow, possibly due to persistent symptoms of depression or anxiety;
• You want to start psychotherapy in Lisbon, but the current situation doesn’t seem conducive to the therapeutic process;
• Look for clinics in Portugal that integrate TMS and psychotherapy in a coordinated manner;
• Do you have questions about the difference between psychology, psychotherapy, and psychoanalysis, and which approach is best for you?
• I would like to know the cost of a treatment plan that combines TMS and psychotherapy in Lisbon.

In short, mental health is neither an exclusively biological nor an exclusively psychological issue. The best response is rarely one-sided either.

How can The Clinic of Change help?

At The Clinic of Change in Lisbon, the integration of TMS and psychotherapy is the norm, not the exception. The team includes psychiatrists specializing in neuromodulation, clinical psychologists, psychoanalysts, and cognitive-behavioral therapy specialists, all working in a coordinated manner. The initial assessment determines not only eligibility for TMS but also the most appropriate type of psychological support—and how to integrate the two throughout the course of treatment.

Schedule your appointment.

Because the brain and the mind are not separate realms—and the best treatment does not choose between one or the other.

Sources:

Hale, M., & Ruffalo, M. L. (2025). From Stimulation to Interpretation: Psychodynamic Aspects of TMS. Psychodynamic Psychiatry, 53(4), 477–483.

Garnaat, S. L. et al. (2019). Updates on TMS Therapy for Major Depressive Disorder. Psychiatric Clinics of North America, 41(3), 419–431.

Huang, M. et al. (2026). Effects of TMS on Patients with Major Depressive Disorder. Clinical Medicine & Research, 24(1), 35–41.

PubMed (2024). A Review of TMS and tDCS Combined with Medication and Psychotherapy for Depression. PMID: 38728568.

Kochanowski, B. et al. (2024). A Review of Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Combined with Medication and Psychotherapy for Depression. PubMed, PMID: 38728568.

This article is for informational purposes only and is not a substitute for a personalized medical consultation. Please contact us.